Treatment options for brain abscess are: 1.Surgical resection: Advantages: complete resection of abscess is theoretically the most ideal method, low recurrence rate, 2 weeks of postoperative antibiotics Yu Xin, Department of Neurosurgery, Naval General Hospital Disadvantages: inevitable damage to surrounding normal brain tissue during resection of cyst wall, long hospital stay, high cost and trauma, especially for those with multiple, deep and functional areas. 2.Stereotactic puncture and drainage of brain abscess: can quickly relieve the occupying effect and brain tissue compression can reduce the medically induced damage caused by brain tissue pulling and separation can reduce the operation time and hospital stay has been accepted by most authors The recurrence rate is high, 14 (19%) of the 72 patients reported by Hakan received 2-4 times re-aspiration due to abscess recurrence and surgical resection [Hakan T; Ceran N; Erdem I; Berkman MZ; Goktas P; Bacterial brain abscesses: an evaluation of 96 cases. J Infect. 2006V52N5:359-66 ]. The mortality rate of puncture aspiration decreased significantly after CT application Mean mortality rate: aspiration 6.6% craniotomy 12.7% Conclusion: aspiration should be the first choice of treatment for brain abscesses in the supratentorial brain parenchyma 3. Although surgical treatment techniques have developed considerably, long-term antibiotic treatment is still as important as surgical treatment itself Recurrence rate reported in the literature: 5% to 50% Recurrence time: within 8 weeks after treatment 4. Cefotaxime (8g/day) + metronidazole (1.5C2g/day) Cefotaxime penetrates into the abscess cavity at a concentration higher than the minimum inhibitory concentration (MIC) of most pathogenic bacteria Metronidazole easily penetrates the blood-brain barrier and is a powerful antibacterial agent against most anaerobic bacteria Other antibiotics of choice: chloramphenicol, penicillin, meropenem, and chloramphenicol. Penicillin, Meropenem, Ceftazidime, Ceftriaxone, Ciprofloxacin, Clorencomycin, Vancomycin, etc. Duration of systemic application: American textbooks recommend high-dose intravenous antibiotics for 6-8 weeks followed by oral medication for 2-3 months, mainly based on Mathisen’s report. The British guidelines recommend a minimum of 4-6 weeks of antibiotics after abscess excision or aspiration, and a minimum of 6-8 weeks of antimicrobial therapy for those treated conservatively. The accepted course of treatment is at least 6 weeks of continuous intravenous antibiotics. Some authors believe that this should be extended to 8-12 weeks but the above data are entirely empirical with a high recurrence rate after treatment of multiple brain abscesses. Some authors believe that patients with multiple brain abscesses require three months of systemic antibiotics, starting with high doses and tapering to maintenance doses [Loftus CM, Osenbach RK, Biller J: Diagnosis and management of brain abscess, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York,McGraw-Hill, 1996, pp 3285C3298.]. One literature reported: 67% of 102 brain abscess patients with drill aspiration, 20% with surgical resection, and 13% with antibiotic therapy alone over a 15-year period Mean antibiotic application time at discharge: 23% of patients with GOS ≤ 31, 3, and 12 months Mortality 11%, 17%, and 19% without recurrent brain abscesses Still considerable disability and mortality rates Type and duration of antibiotic application related to outcome Drug Side effects: mostly reversible incidence 60% Time: the vast majority in the 3rd week of treatment Affects treatment: 18% of 66 patients treated with drugs completed an adequate course of treatment 58% Discontinuation of treatment due to drug side effects is the main reason for the high incidence of side effects associated with high doses of drugs applied for long periods of time [A.-K. Jansson ? P. Enblad ? J. Sjlin.Efficacy and Safety of Cefotaxime in Combination with Metronidazole for Empirical Treatment of Brain Abscess in Clinical Practice:A Eur J Clin Microbiol Infect Dis (2004) 23:7C14. DOI 10.1007/s10096-003-1055-7] Martin compared the efficacy of carbapenems alone with that of CSC. Efficacy: It was concluded that carbapenems are more effective than CSC Meropenem is as effective as imipenem but has a significantly lower incidence of seizures and is therefore a better choice for the treatment of brain abscesses It has recently been suggested that the course of intravenous antibiotic application can be shortened by 1-2 weeks on the basis of subsequent adequate oral antibiotics Taking into account the clinical and antimicrobial effects of combined treatment with CSC. It can be hypothesized that similar results would be achieved in patients with significant clinical and imaging improvement after surgical treatment if switched to oral agents but the above proposal requires clinical confirmation.